Nov 17, 2018

1. Deep Dive: The drug pricing maze

Illustration: Sarah Grillo/Axios

The system for setting drug prices in the U.S. is a labyrinth. It can be enormously frustrating for patients — and enormously rewarding for the drug companies, pharmacies, doctors, hospitals and assorted middlemen that profit along the way.

The big picture: The cost of a drug depends on many factors: whether it’s a brand-name product or a generic; secretive industry negotiations; even the way the drug is administered. Each patient's price may be different.

  • “There’s so much variability, and that’s where all the money is being made,” said Eric Pachman, a former pharmacy manager who co-founded the drug data firm 46brooklyn Research.

How it works: Using publicly available data and common industry assumptions, Pachman built out a rough, simplified sketch of how money changes hands for a “typical” generic drug.

  • This drug would cost about $3 to make and would sell for about $15.
  • So, what happens to the other $12? It’s split among the manufacturer (about $3), the pharmacy ($1.50), a wholesaler ($2), and, finally, the largest share goes to the company that manages your insurance plan’s drug benefits ($5.50).

The numbers would look a lot different for the more expensive brand-name products that drive most of America’s drug spending. Those are the ones you’ve probably heard of, like the Epi-Pen or Humira, the world’s top-selling drug.

  • They often start with high sticker prices. Humira’s is more than $58,000 per year, according to Elsevier's Gold Standard Drug Database.
  • Different insurance plans negotiate different discounts off that list price. All of them are kept secret. The negotiators also keep some of the savings for themselves. That number, too, is a secret.
  • There’s a whole different pricing system for drugs administered by a doctor, and yet another system for certain hospitals.

The bottom line: It’s a free-for-all behind the scenes.

  • “The system is vulnerable, and you can abuse it,” said Mick Kolassa, a retired consultant who helped drug companies with pricing practices for almost 40 years.

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LATAM Airlines files for U.S. chapter 11 bankruptcy

A LATAM air attendant aboard one of the company's planes in March. Photo: Kike Calvo/Universal Images Group via Getty Images

LATAM Airlines Group SA said in a statement early Tuesday the firm and its affiliates in in the United States, Chile, Peru, Colombia and Ecuador have filed for Chapter 11 bankruptcy protection in the U.S.

Why it matters: Latam is Latin America's largest airline and its shareholders include Delta Air Lines. CEO Roberto Alvo noted in the statement the coronavirus pandemic has had a huge impact on the airline industry.

Novavax starts human trials for coronavirus vaccine

Novavax's Nita Patel with a computer model showing the protein structure of a potential coronavirus vaccine at the lab in Gaithersburg, Maryland in March. Photo: Andrew Caballero-Reynolds/AFP via Getty Images

Novavax began clinical trials of a vaccine for the novel coronavirus in Australia on Tuesday, per a statement from the Maryland-based biotechnology firm.

The state of play: 131 volunteers in the Australian cities of Melbourne and Brisbane will undergo injections as part of the study, the company’s research chief Gregory Glenn said during a briefing, per Australian Associated Press.

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Global: Total confirmed cases as of 12:30 a.m. ET: 5,495,061 — Total deaths: 346,232 — Total recoveries — 2,231,738Map.
  2. U.S.: Total confirmed cases as of 12:30 a.m. ET: 1,662,302 — Total deaths: 98,220 — Total recoveries: 379,157 — Total tested: 14,604,942Map.
  3. World: Italy reports lowest number of new cases since February — Ireland reports no new coronavirus deaths on Monday for the first time since March 21 — WHO suspends trial of hydroxychloroquine over safety concerns.
  4. 2020: Trump threatens to move Republican convention from North Carolina — Joe Biden makes first public appearance in two months.
  5. Public health: Officials are urging Americans to wear masks over Memorial Day.
  6. Economy: New York stock exchange to reopen its floor on Tuesday — White House economic adviser Kevin Hassett says it's possible the unemployment rate could still be in double digits by November's election — Charities refocus their efforts to fill gaps left by government.
  7. What should I do? Hydroxychloroquine questions answeredTraveling, asthma, dishes, disinfectants and being contagiousMasks, lending books and self-isolatingExercise, laundry, what counts as soap — Pets, moving and personal healthAnswers about the virus from Axios expertsWhat to know about social distancingHow to minimize your risk.
  8. Other resources: CDC on how to avoid the virus, what to do if you get it, the right mask to wear.

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Updated 2 hours ago - Politics & Policy